Christian Dean and Sam Selby are not worried about a worsening shortage of primary care physicians in Texas.

They're practically looking forward to it.

As second-year students at the Texas College of Osteopathic Medicine in Fort Worth, Dean and Selby are among almost 100 students in their class expected to pursue a practice in primary care despite the changes that loom from healthcare reform.

"I enjoy having a huge range of patients, both in terms of age and with different problems," Dean said. "I enjoy interacting with kids, and I enjoy talking to older folks, who normally have great stories. ... I'm not worried about my ability to make a living."

Selby agrees.

"Medicine is going to be something that's always needed," he said. "My income might fluctuate. It might not be as good as doctors in the past, or it might be better, but I'm always going to be able to provide for my family.

"There's always going to be a need for doctors."

More than half the college's graduates each year accept residencies in primary care fields such as family practice, internal medicine, pediatrics and obstetrics-gynecology, making it a top producer of primary care physicians in the state.

And with enrollment expected to increase nearly 25 percent in coming years, those numbers are expected to grow.

"We've been providing a large number of primary care providers since our inception 35 years ago," said Don Peska, dean of the college. "This is truly a commitment for us, and we've been very successful at this strategy."

Looking for reinforcements

Texas ranks 46th in the nation in the prevalence of physicians, with about 175 for every 100,000 residents. Those include allopathic physicians, with M.D. degrees, and osteopathic physicians, with D.O. degrees.

Primary care physicians are most in demand, with some facilities using signing bonuses to lure physicians, according to a report last year by Irving-based Merritt Hawkins & Associates, a national physician search firm.

As the population grows, the supply of primary care doctors is shrinking -- medical students are increasingly interested in specialties, and the physician work force is aging. The shortage in primary care is expected to worsen as healthcare reform provides access to doctors for millions of now uninsured Americans.

While applications to medical schools increased 40 percent between 2002 and 2008, medical schools are limited in their growth by tightening state budgets and a finite number of residencies.

Four schools in Texas added 20 slots for students during that period, according to the Texas Higher Education Coordinating Board.

The Texas College of Osteopathic Medicine, which operates through the University of North Texas Health Science Center, has increased its enrollment to 200 this year and is expected to increase it to about 230 in coming years. The UNT regents have also taken the first steps toward offering M.D. degrees, although that is subject to approval by the Legislature.

Healthcare reform has not dissuaded students from planning to go into primary care, Peska said.

"I think they are less reticent about going into primary care practices," he said. "Their concern was there would be a diminishing number of patients able to pay the bill."

Looking ahead

Dean, 27, who grew up in Dallas, started as a paramedic and obtained a master's degree in biomedical science at the UNT Health Science Center before deciding to continue on to medical school.

"I want to do patient care," he said. "My dad's a physician [in Dallas], and I've seen what rewards there can be, both living with him and working in different patient care settings.

"It's something I've always wanted to do."

He chose the Texas College of Osteopathic Medicine because "it has a great reputation for making great primary care physicians, and I did get a master's degree here," he said.

Selby, 25, who grew up in Abilene, said he became interested in medicine after an aptitude test indicated that he was strong in biology. His father, too, is a physician.

"I didn't know much about osteopathic medicine, but when I found out more about it, I found out the values meshed with mine," he said. "It's a holistic, whole-body approach."

Selby recently married a nurse, Jessica, who works in the neonatal intensive care unit at Cook Children's Medical Center. He believes that primary care will match his interests best.

"I never see myself going into a specialty," he said. "I like seeing the whole person. I like forming relationships, and I feel primary care helps me make that connection. ... I see myself seeing the whole span of human beings."